Food-borne Diseases Part – 2

CHOLERA
• Cholera is an acute diarrheal illness caused by infection of the intestine with the bacteria Vibrio cholerae
• Natural infection with cholera occurs only in human
• Infection is through oral route
• Its source is contaminated food and water
• In most cases it present as profuse, painless, watery diarrhea and copious effortless vomiting , this may lead to
hypovolemic shock and death less than 24 hr.
• With fluid replacement and antibiotics the disease may last 4-6 days
Vibrio cholerae
• V. cholerae is a short , curved , rod shaped , actively motile by polar flagellum.
• The name vibrio is derived from its characteristic vibratory motility( from vibrare mean to vibrate)
• Flippo pacini first identify and described the name of organism V. cholera after isolating it from cholera patient
• They are actively motile described as darting motility
CLASSIFICATION
• Based on requirement of sodium chloride they are of two type; Halophilic (V .parahemolyticus) and Non halophilic(
V. cholerae)
• Serological classification was introduced by Gardner and Venkatraman (1935) based on major somatic antigen.
SYMPTOMS
• The symptoms of cholera are nausea , vomiting , diarrhea, dehydration etc..
• The cholera stool is typically colorless resembles to rice water known as “Rice water stool”.

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• Incubation period is less than 24 hr to about 5 days.

• Complication are muscular cramps, renal failure , pulmonary edema etc..

• Vibrio multiply on the intestinal epithelium produce an entero toxin known as Cholera toxin (CT)
RISK FACTORS
Poor sanitary conditions –
• Rare in developed countries
• Common in Asia, Africa, & Latin America
Raw or undercooked food
• Contaminated seafood, even in developed countries.
• Especially shellfish.
Hypochlorhydria
• People with low levels of stomach acid
• Such as children, older adults, and some medications.
Type O blood
• Reasons aren't entirely clear
• Twice more likely
DIAGNOSIS
• As V. cholerae die with in few hour it preserve in holding( transport media ) such as Cary Blair medium or
Venkatraman – Ramakrishnan (VR) medium.
• Selective media of V. cholerae is Thiosulphate citrate bile salt sucrose agar (TCBS) ( yellow colour colony on green
colour media )
• Test used for its identification is string test
VACCINES
Parenteral Vaccine:
• 2 doses administered 2 weeks apart
• Efficacy of approximately 50% and hardly exceeds 6 months
• Not recommended
Killed WC/rBS Vaccine:
• Killed whole-cell recombinant B-subunit of cholera toxin
• Safe in pregnancy and breastfeeding
• Efficacy of approximately 50% after 3 years
• Only mild side effects
TREATMENT
• Adequate replacement of fluid and electrolyte by Oral rehydration salt (ORS)

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• This can be done either alone or supplemented by intravenous fluids
• Antibacterial therapy
• Vibrio vulnificus can also be isolated from seafoods and seawater.

• The organism is highly invasive, releasing both a hemolysin and a cytotoxin, and can result in primary septicemia in
humans

E.coli DIARRHEAS
E. Coli
• E. coli is gram negative , straight rod arranged singly or in pairs
• It is motile by peritrichous flagella
• Capsule and fimbriae found in virulent strains
• This genus is named after Escherich (1885) who was first to describe it
• E. coli is human enteric flora, living in the human or animal intestine
Antigenic structure
• Somatic antigen (O antigen ): It exerts endotoxic activity
• Flagellar antigen (H antigen): found on flagella
• Capsular antigen( K antigen):Located in envelope and microcapsule
Virulence factors
1. Surface antigen:
i. O antigen
ii. KI envelope antigen : this strains causing neonatal meningitis and septicemia
iii. F antigen : Fimbriae are important virulence factors

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2. Toxins
i. Haemolysin
ii. Enterotoxin : they are of 3 type ; heat labile, heat stable, Shiga like toxin
Type of enterotoxins
1. Heat labile toxin (LT) of E. coli was discovered in 1956 by De and Colleagues in isolates from adult diarrhea cases
in Kolkata.
• It is complex polypeptide consist of one subunit A and five subunit B
2. Heat stable toxin (ST) of E. coli was discovered in 1970 and comprises low molecular weight polypeptide which
are poorly antigenic
3. Verotoxin /Verocytotoxin so named because of cytotoxic effect of vero cells
Clinical infections
i. Urinary tract infection
ii. Diarrhea
iii. Septicemia , neonatal sepsis and neonatal meningitis
iv. pyogenic infections
Diarrhea
• In1945 Bray established the causative role of E. coli during hospital out break of diarrhea
• There are five diarrheagenic E.coli
1. Enteropathogenic E.coli(EPEC) : It is associated with diarrhea in infants and children

• It is non invasive and do not produce enterotoxin

2. Enterotoxigenic E.coli (ETEC) : Two epidemiological types are ;
a. Endemic in developing countries of tropics seen in all age group it range from mild watery diarrhea to a fatal
disease .
b. Traveller’s diarrhea seen in person from non endemic areas visiting endemic are
• ETEC produce enterotoxin which may be either LT or ST
3. Enteroinvasive E.coli ( EIEC) : They have capacity to invade interstitial epithelial cells
4. Enterohemorrhagic E.coli (EHEC) : These strains produce two type of potent toxin , verotoxin(VT) or shiga like
toxin(SLT)
• They can give rise to fatal hemorrhagic colitis and hemorrhagic uremic syndrome (HUS) in young children and in
elders
5. Enteroaggregative E.coli (EAEC) : Associated with persistent diarrhea
• Incubation period 8-24 hr for invasive type and 8-44 hr for enterotoxigenic type
• Fever, headache, abdominal cramp, profuse, watery diarrhea are common symptoms
• To control this cook food thoroughly, practice personal hygiene , dispose sewage in sanitary manner

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Name Hosts Description

Enterotoxigenic E. coli (ETEC)
Enteropathogenic E. coli (EPEC)
Humans, pigs, sheep, goats, cattle,
dogs, and horses
Humans, rabbits, dogs, cats and
horses
• Non-invasive strains.
• Cause diarrhea in children, as
well as traveler's diarrhea.
• Produces a heat-stable (ST)
enterotoxin
• 200 million cases of diarrhea
and 380,000 deaths each
year.
• Has an array of virulence
factors similar to Shigella
toxin
• Moderately invasive and
elicit an inflammatory
immune response.

Enteroinvasive E. coli (EIEC) found only in humans • Causes a syndrome that is

identical to Shigellosis, with
profuse diarrhea and high
fever.

Enterohemorrhagic Humans, cattle, and • The most famous member of

E. coli (EHНЕС) goats this virotype is strain
O157:H7, which causes
bloody diarrhea

SHIGELLOSIS
DYSENTERY
• Dysentery is a clinical condition characterized by the frequent passage of blood stained mucopurulent stools
• Two common type of dysentery are :
i. Bacillary dysentery

ii. Amoebic dysentery

• Bacillary dysentery is caused by Shigella

• In 1896, Shiga isolated the first member of the genus Shigella from epidemic dysentery in Japan
Shigella
• They are short, gram negative rods
• They are non motile , non sporing and non capsulated , fimbriae maybe present
• S. dysenteriae form an exotoxin known as shiga toxin
• Three type of toxicity shown by S. dysenteriae are neurotoxicity, cytotoxicity, enterotoxicity
• Y. enterocolitica has been isolated from many foods, including beef. pork, liquid eggs, soft cheese, raw milk,
pasteurized milk. fish, raw oysters. shrimps, crabs, chocolate milk, powdered milk
• Symptoms :severe abdominal pain, fever, and diarrhea, occur 24 to 36 hr after consumption of the product.

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• The isolation from pasteurized milk is probably the result of post pasteurization contamination, since even the most
heat-resistant strains are reported to be killed by pasteurization. CLASSIFICATION
Shigella is classified into four subgroup or species based on biochemical serological characteristics
• S.dysenteriae (Subgroup A)
• S.flexinari (Subgroup B)
• S.boydii (Subgroup C)
• S.sonnei(Subgroup D)
Bacillary dysentery
• This disease has a short incubation period(1-7 days, 48 hours)
• Clinical features include loose , scanty feces containing blood and mucus along with abdominal cramps , fever, chill,
diarrhea ,tenesmus , headache
• Moist, mixed foods; milk, beans; potato, tuna , shrimp, salad apple cider are main food items cause shigellosis
• Complication of shigellosis include Hemolytic uremic syndrome’
PREVENTION AND TREATMENT
• Shigellosis can be controlled by practicing personal hygiene , prepare food in sanitary manner, protect and treat
water, dispose of sewage in sanitary manner
• Uncomplicated shigellosis is self limiting conditions
• In acute cases in infants and young children dehydration has to be corrected , oral rehydration adequate in most cases
Yersinia enterocolitica
• Yersinia enterocolitica is a small rod-shaped bacteria that can cause gastrointestinal illness in humans.
• isolated from the intestinal tracts and feces of many animals, including cats, pigs, dogs, deer, raccoons, and horses
• The pig appears to be the main reservoir for the strains causing infection in humans.
• The unique characteristic of the organism is its ability to grow at commercial refrigeration temperatures, i.e., less
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Campylobacter
• Campylobacter, i.e., C. jejuni and C. coli, are the strains most frequently associated with acute gastroenteritis in
humans.
• inactivated at temperatures above 45 to 50 C
• Sensitivity to drying, sensitivity to acid conditions, and being a poor competitor in mixed populations because of an
inability to utilize carbohydrates
• Little is known about mechanism the actual of pathogenicity in humans; however, at least some strains produce a
heat-labile enterotoxin
• Symptoms :abdominal pain, cramps, diarrhea, headache, fever, and occasionally bloody stools.
• The incubation time is usually 2 to 3 days but may be as long as 7 to 10 days.
• Pasteurization of milk or the proper cooking of foods prior to consumption would eliminate many outbreaks.
• Since Campylobacter are widespread in foods of animal origin care must be taken to avoid cross contamination from
raw meats to cooked item.
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